DETERMINANTS OF MODERN TOOLS FOR MATERIAL …

www.wjpr.net Vol 6, Issue 8, 2017.

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Modi. World Journal of Pharmaceutical Research

DETERMINANTS OF MODERN TOOLS FOR MATERIAL

MANAGEMENT AT URBAN HEALTH CENTRE, GANDHIDHAM

*Bhupendra S. Modi

*Lecturer, Tolani Institute of Pharmacy, Adipur. 370205.

ABSTRACT

The entire gamut of purchasing, storage, inventory control,

distribution now forms a discipline called materials

management; and in future, more hospitals are going to adopt

material management (MM) orientation. It is the science that deals

with the raw materials procurements, obtaining machines and

equipments, which are necessary for the service provider and it also

includes the upkeep and maintenance of the premises and making

available the consumables, spares and reagents required for providing

the quality services to customers by service provider. Every enterprise

requires materials as inputs for providing the desired services. Hence

the success of an enterprise depend to a large extent on the efficient and judicious use and

procurement of materials and other inputs. Materials management is a fundamental tool of the

Business which adds value directly to the product itself. Materials management is the

planning, directing, controlling the activities which are related with the materials and

inventory requirements from the point of their inception to their introduction into the process.

It deals with the regulating and controlling the flow of materials in relation to the changes in

the variables like demand, price, availability, quality, delivery schedule etc.

KEYWORDS: Urban health centre, Inventory, Hospital formulary, Pharmacy and

therapeutic committee.

INFORMATION UHC, GANDHIDHAM

The Urban Health Centre, Gandhidham is situated in the premises of Rambaugh hospital. The

centre is established in the year 2011. The centre offers best possible service to the

community of the area by 05 UPHCs, located in Cargo slum, Sunderpuri slum, Nagarpalika

World Journal of Pharmaceutical Research SJIF Impact Factor 7.523

Volume 6, Issue 8, 1361-1372. Research Article ISSN 2277– 7105

*Corresponding Author

Bhupendra S. Modi

Lecturer, Tolani Institute

of Pharmacy, Adipur.

370205.

Article Received on

26 May 2017,

Revised on 16 June 2017,

Accepted on 06 July 2017

DOI: 10.20959/wjpr20178-8992


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Adipur, Rambaugh and Ganeshnagar, i.e. slum dwelling regions. Providing both clinical and

also the out-reach services. Various national programmes are also implemented in the area.

UHC, Campus

Area: 0.3 Sq. KM

Location: Adipur Police Station road, Gandhidham.

Building: Single storied building with 07 Functional units, Administrative office, Doctor

room, Pharmacy counter, Injection room, Vaccine store, Pathology laboratory and

Community Hall.

Public health laboratory: It undertakes investigations like routine blood & urine, sugar,

lipid profile, Widal, VDRL, pregnancy test, MP, etc.

Demography: Estimated total population of the service area is 247992 (estimated as per

census 2011) out of which slum population is 88434, which equals to 35.70% of total

population.

Other stakeholders: Sub district hospital, Private sector hospitals, Industrial workers, as

Gandhidham is Industrial hub, NGOs, School and College students as 7000 students studying

in Tolani Vidhya Mandir Campus, Adipur.

ACTUAL PRACTICES

Procurement: Drugs, surgical items, reagents, antiseptics, disinfectants are supplied by

Gujarat Medical Service corp. Ltd. (GMSCL), Jamnagar warehouse by online indenting in E

Aaushadhi program. Vaccines, School health medicine, Family planning medicine, Epidemic

medicine and Reproductive child health (RCH) medicines are supplied by District Medical

Store, Bhuj. Yearly indent procedure is there. Supplementary indent may be given, if required

in case of all the drugs. Indent is generated on the basis of past consumption traits and

practical experience of pharmacist. They are indenting 20% higher than the last year‟s

consumption.

Indent is generated by pharmacist and endorsed by Urban health centre Medical officer. In

Epidemics when there is huge demand for a particular drug is more, it is provided by district

drug store. Ancillary items from the GMSCL or District store, the same is inspected by the

pharmacist both in terms of number and physical condition of the packages and materials

received,(against delivery challan) if any discrepancy is observed then it will be informed to


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warehouse and necessary action will be taken as per instructions of GMSCL warehouse. The

received material is credited in the stock register meant for it. e.g. Stock register for Tablet,

Capsule, Injection, Vaccines, Surgical items, Miscellaneous items etc. For equipments and

drugs not provided by GMSCL and District store, local purchase can be done, and if costing

of the item is more than Rs.1000, Urban Medical officer will institute procedure for bid

inviting and lower bidder will be selected.

Storage and distribution of drugs

The responsibility store keeping is lies with senior pharmacist. Material from store is issued

on the request to the hospital pharmacy and nursing station for dispensing and administration,

the same is debited in the respective stock register. They are keeping emergency drugs kit

ready for Indoor as well as Outdoor patients, the responsibility of up keeping of this kit lies

with pharmacist. Poisonous and schedule X drugs is kept in cupboard with lock and key.

Black disinfectant is stored separately. Precautions were taken to store injection and

ointments in a cool dry place protected from light. Room temperature and Relative humidity

is recorded once in a day. Temperature should not be more than 30 degree centigrade and

Relative humidity should not more than 60% for routine drugs. Hygroscopic materials they

are keeping in corrugated boxes (7 ply) only, and keeping small quantity on racks as per

requirement, on the upper portion of rack. Drugs should not be stored in vaccine store, except

diluents of vaccines. Textile stores is regularly examined for dampness, mildew and fungus

and when these are noticed they should be spread out and sun dried. A review is be made by

concerned pharmacist in first week of every month to identify the medicine whose expiry

date falls with in six months, hence it can be consumed or necessary arrangements can be

done to transfer it to the hospital. where it is required. Following “first in first out” (FIFO)

policy for all the items by keeping new stock of particular item on back side of old stock,

hence front item will be moved first.

Storage of vaccine

Vaccines are stored in ILR (Ice lined refrigerator) Temperature 2-8 C.

Deep freeze provision

was there for formation of Ice packs. Provision of digital thermometer for measurement of

temperature. Preventive maintenance of ILR/Deep freeze is carried out once in a month. Hold

over time for ILR in case of power cut off is 8 to 10 hrs. Cold box with ice packs can

preserve vaccines for 02 days. Temperature monitoring is done by pharmacist two times in a


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day (10:00hr and 16:00hr). At district level post of technician for repair and maintenance of

ILR and deep freeze. Adequate number of vaccine carrier were there for field Immunization.

Condemnation

For condemnation of drug store items a condemnation committee is to be setup, comprising

of medical officers, pharmacists and nursing staff. This committee meets once in a year to

review the position regarding stocking of various items of store and such items which are no

longer needed or expired are condemned or disposed suitably.

Theft prevention

Provision of single entry/exit was there. Costly items kept in cupboard with lock and key.

In/out register for man and material is maintained. Personnel entry is curtailed. Windows are

provided with iron grills as measure of security.

Audit

Monthly physical verification is done by pharmacist against stock registers for tablets,

capsules, surgical items, ointments, injections, syrup and vaccines. Audit branch of CMS will

carry out stock audit i.e. cross verification of stock registers with physical availability of

drugs.

Quality Assurance

Monthly random sample collection by drug inspector for analysis, and sending it to drug

control Laboratory, if it does not complies with pharmacopoeial standards then it is

considered not of standard quality and withdrawal is done from dispensing and marked as

“Stop for patient‟s use”. Entire stock pertaining to that B.No. is kept as rejected; and disposal

is done as per standard procedure. However chances of not of standard quality is less at

hospital store as GMSCL is following 100% pretesting policy before distribution. If sample

failed by drug control laboratory at GMSCL level, it will not be distributed for further use,

and declared as „Not of standard quality‟. In such case FDA will inform to other stake holders

also, who are purchasing directly from the suppliers. Stock of „Not of standard quality‟ is

retained and marked as “Not Approved” with red Label. If repetitively sample failures of the

particular supplier is reported, then that supplier is removed from approved vendor category

and rate contract will be terminated automatically. In that case next rate contract supplier will

be preferred, and if he does not acknowledge the purchase order then purchase shall be done

from open market, strictly at the price mentioned for RC (Rate Contract) suppliers.


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METHODOLOGY OF INVENTORY ANALYSIS

Inventory control is basically a scientific system which indicates what to order, when to

order, how much to order, how often to order so that the purchasing costs and storing costs

are kept as low as possible. The two basic techniques of inventory control, which can be very

effectively used in the medical stores, are A-B-C analysis and V-E-D analysis. Inventory

analysis helps the materials managers to exercise selective control and focus his attention

only on a few important items when he is confronted with thousand of store items.

A-B-C Analysis

A-B-C analysis is a basic analytical management tool, which enables any store managers to

provide the best result of his efforts. This analysis is purely based on Selective Management

Principle or Pareto‟s Law. It is also popularly known as “Always Better Control”, has

universal application in many areas of human endeavour. A-B-C analysis does not depend on

the unit cost of the items but also on its annual usage and not on their importance because all

items are important. Analysts commonly classify inventory into three categories „A‟, „B‟, and

„C‟. The „A‟ items have a high annual usage in terms of monetary investment. „B‟ items are

average, while „C‟ items have a low value of usage. Every item in inventory is ranked and

listed in order of item‟s annual value of usage. At the top of list would be the high value

items, followed by a longer list of medium value items and finally a list of low value items.

The dividing line between classes of items is arbitrary.

Mechanics of A-B-C Analysis: The mechanics of classifying the items into „A‟, ‟B‟ and „C‟

categories is described in the following steps:

Calculate rupee annual issues for each item in inventory by multiplying the unit cost by the

number of units issued in a year. It is assumed that the issues and consumption are the same.

Sort all items by rupee annual issues in descending sequence. Prepare a list from these ranked

items showing item no., unit cost, annual units issued and annual rupee value of units issued.

Starting at the top of the list, compute a running total, item-by –item issue value and the

rupee consumption value i.e. cumulative cost of the items. Compute and print for each item

the cumulative percentages for the item count and cumulative annual issue value.

Hence from the A-B-C analysis of drug list of Urban Health Centre, consisting of 226 items

of store, of which there were,


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Group „A‟ 2 % items 70% of the total expenditure

Group „B‟ 10 % items 20% of the total expenditure

Group „C‟ 88 % items 10% of the total expenditure

This is how the A-B-C analysis is done for classifying the items of any drug store into Group

„A‟ Group „B‟ and Group „C‟ items.

V-E-D Analysis

The limitation of A-B-C analysis is that it is based only on monetary value and the rate of

consumption of the items. Sometimes, particularly in a hospital, an item of low monetary

value and consumption (e.g. Injection Adrenaline, Anti-Snake Venom etc.) may be very vital

or even life saving. Their importance cannot be overlooked simple because they do not

appear in A category of inventory. Therefore, another parameter of the materials is their

criticality. This could be in terms of the therapeutic value of a drug or intrinsic value of the

material in achieving the objectives of hospital system. V-E-D analysis is based on critical

values and shortage costs of the item. Based on their criticality, the items could be classified

into three categories –Vital, Essential and Desirable.


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Combination of A-B-C and V-E-D Analysis

A combination of A-B-C and V-E-D analysis can be gainfully employed to evolve a

meaningful control over the material supplies particularly in a hospital system.

There are two models of this combination, which are generally in use as shown in Fig.

Models

Category I includes all vital and expensive items. These require close monitoring and strict

control. Category II covers items of essential category and they are less expensive. Category

III comprises the desirable and cheaper group of items.

Modern methods of Inventory control

Provision of biometric readers in drug store to restrict the entry only to the licensed

professional. Inside the pharmacy additional restriction to specific drug areas by automated

drug cabinets and dispensing devices, which also require another level of security such as

biometric reader access or user name and password access. To prevent expiration of drugs

daily reviews of expiration dates by computerized programs and physical verification. Use of

automated inventory management and dispensing devices and tools for monitoring the

procurement processes, which are automatic rather than manual (carousels). Carousels can be


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connected to the pharmacy‟s drug ordering system this allows the carousel to track which

drugs have been ordered so when the drug are placed into inventory, the quantities will either

automatically match or show a discrepancy that needs to be investigated and resolved. For the

purchase of controlled substances, supporting documentation and additional reviews are to be

maintained to overcome high risk nature of these drugs. Follow Hospital Formulary. PTC is

prerequisite for framing and implementation of Formulary. Formulary is framed by PTC

(Pharmacy and therapeutic committee) members. When formulary is followed number of

store items will be less. Formulary also enhances quality and cost of therapy. Formulary is

not merely list of drugs, it also includes drug‟s pharmacological actions, indications, dose

possible adverse drug reactions, special precaution for administration if any, drug- drug

reactions, drug food reactions, therapeutic index etc. Criteria for selecting drug product

manufacturer should be rigid, inspection of manufacturer‟s unit is essential and only after

satisfactory compliance of Production facilities, Quality control facilities, Quality assurance,

utility services, approval should be given to the manufacturer as Approved vendor. Web

based tool for ordering and tracking shipments, replacements of inventories. The system

performs tracking at the site and depot level. It eliminates the need of paper and minimizes

human error. The system generates alerts when inventory drops below a predefined threshold,

reducing the chances of insufficient drug supply.

OBSERVATIONS AND RECOMMENDATIONS

ABC analysis VED analysis

Type of Item as

perABC

analysis

Number

of items

Contribution

in Percentage

Type of Item

as per VED

analysis

Number of

Items

Percentage

Contribution

A 04 1.77% Vital 19 8.41

B 24 10.62% Essential 151 66.81

C 198 87.61% Desirable 56 24.78

Categorization based on ABC and VED Analysis

Categorization based

on ABC /VED Analysis

Number of

Items

Contributing

Percentage %

AV 0 0

AE 04 1.77

AD 0 0

BV 0 0

BE 18 7.96

BD 06 2.65

CV 19 8.41

CE 129 57.08

CD 50 22.12


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From above tabulation is analyzed that, Vital items are 8.41% only, as at UPHC level we are

mainly providing primary health care. We have to ensure its availability at any given point of

time. We have to focus mainly on CE category for inventory control, as it is contributing

57.08% of total items and are essential. No item belongs to AV and BV category, means at

UPHC level no costlier vital item, so we have to keep excess stock of CV items, as they are

cheaper and vital too. Give indent requisition for the year. Percentage of A and B items are

less in terms of quantity i.e. 1.77% (04 items) and 10.62% (24 items) respectively, as Urban

health centre runs vaccination program and vaccines are quite costlier and its consumption

rate is also high, hence 70% cost is incurred by only 04 items and considered as A items, next

20% cost is incurred by 24 items and considered as B items. Here 90% cost is incurred by 28

items falling under A and B items as per ABC analysis. Rest10% cost is incurred by 198

items out of 226 items and contributing 87.61% of total volume of items. Demand and supply

gape is all most Nil except for ointments and liquid orals. It is the advantage of central

purchasing organisation.

Here in the following table, found interesting fact that items in the following table are

vital one and cheaper too, but quantity purchased for the entire year is very less, the entire

cumulative cost of all these items is Rs.1721. Total population under UHC is 247992 and

our targeted slum population is 88434. Here the question arises that this much quantity

will be adequate for accidental future needs. We can keep these items in excess, space

occupied by them will be less.

Name of the drug item Unit cost

In Rs.

Quantity

purchased

Amount in

Rs.

Dexamethasone Inj.Injection 2.28 250 570

Adrenaline Injection 1.52 250 380

Methyl Ergometrine Inj. 3.21 125 401

Frusemide Injection 1.48 250 370

Material management is important management tool which will be very useful for assuring

the quality, quantity and economy of the hospital materials. Quality and cost are critical

dimensions. As we are dealing with drugs, we have to be judicious. We can not compromise

with quality of drug products considering cost factor. On the other hand we have to provide

cost effective medication to our patients. Patient delight is important for survival of any

organization, by observing principles of material management we can satisfy our patients up

to certain extent by proving safe, cost effective and uninterrupted drugs supply. Potency of


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the drug product is directly depend on the proper storage, i.e. specified temperature, relative

humidity, protection from light etc. for the particular product. We have to provide medicinal

supply without undue delay. By codification and proper storage methods we can assure easy

accessibility of materials. Hospital Formulary is the need of hour.

Material management at both level outside i.e. purchase as well as inside the hospital i.e.

storage and distribution system needs attention. Efficacy of the product is dependent on

proper method of administration, dosage, frequency, vehicle, time of administration. Patient‟s

counselling and coordination between Doctors, Pharmacist and Nursing staff plays great role

in it. The procurement of sterile and non sterile pharmaceutical products in a hospital is

related to the requirements of the hospital in a given period of time. Since procurement is to

be rated to the future demand, a correct estimation of future demand called forecasting is

necessary.

It can be estimated judgments based on experience that will be required of a particular

pharmaceutical product.

The past consumption pattern of hospital is extended to the future by constructing a time

series and extrapolating it. Casual models should also be adopted. e.g. demand of antibiotics

is related to the total number of patients with Infections amenable to that antibiotic admitted

every month etc., regression analysis is used to arrive at an estimate.

MCR (Monthly consumption rate) should not be taken into consideration for vital items.

Inflammable material like gauze, cotton/bandage, cotton wool etc stored along with drugs. It

is better to store it in a separate place. In store exhaust provision was not there, it should be

provided for better circulation of air.

Height of ceiling in drug store was 11 feet from floor, it should be at least 20 feet from floor,

alternatively false ceiling should be there, for prevention of heat. Storage of surgical gloves

and other rubber items was not proper. The melting point of rubber being law, high

temperature tends to destruction, it is essential to store rubber gloves at a temperature of

about 27 degree Celsius and to achieve it cool and dark place is required.

ABC and VED methods for inventory control is not followed in my study centre, However

they are keeping adequate stock of emergency items. As per ABC analysis „A‟ items are of


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highest value and required in large number/quantity, they should be purchased more

frequently as and when indicated by the stocked reaching the re-order level, for C items it is

better to order the requirement annually. List of Vital, Essential and Desirable items was not

there, it should be prepared by consulting a team of doctors and should be revised at least

once in a year. After ABC and VED analysis they should be correlated to work out the level

of reserve and safety stocks. After analysing the item in terms of ABC/VED, proper

inventory levels should be fixed for items falling in different classifications. Full use of

available accommodation was not there in store, one way of doing this would be to provide

shelves up to a greater height. Bottles, medicines with bigger packing‟s and fast moving

items should be stored in lower portion of the shelves. Items which are light in weight and

requiring more space should be stored in upper portion of shelves. Lead time for all

categories of items should be calculated.

Work out the safety stock for each item, safety stock is the quantity of stores set apart as

insurance against the variations in demand during the lead time. Reorder level, denotes the

stock levels at which fresh order has to be placed; this is the sum of the safety stock and the

consumption during lead time, to prevent out of stock crisis.

In store number of tablet blisters were found, i.e. out of carton, may lead to deterioration and

contamination. After issue remaining material should be placed in the original carton of that

particular product.

Glass of windows of store were transparent, it can be provided with umber colour glass to

provide protection against sun light.

As per standards laid down by National Board of Accreditation (NABH) 4th

edition

December 2015, entire chapter is given on management of medication (MOM), considering

its importance. Principles of Material management had direct bearing on any form of

organization either government, private, corporate, trust, small or large scale hospitals and

even in our day to day life. Store in charge has to ensure that vital items (as per VED

analysis) must be present at any given period of time, as it may be matter of life and death of

patient. Adequate buffer stock must be maintained for Vital items. Chief pharmacist should

be cautious while giving purchase order of category AD items (as per combination of ABC

and VED analysis), as these items are costlier and desirable items and may lead to blockage

of investment and space. For CV type of items safety stock should be high.


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Storage of drugs based on Alphabetical method is good when no. of store items are less, but

in drug store Pharmacological categorization of drugs and sub classification based on

alphabetical method is best to cover large number of drug items and for their easy

accessibility. Patient centred pharmacy services is the need of hour as hospital services is

profession not merely business and we are dealing with suffered community.

As material management ensures continuous health care services, tools of inventory control

must be practiced.

Even a common man must know the basics of material management so that he can get the

best of the available resources and make it a habit to adopt the principles of material

management in all our daily activities.

REFERENCES

1. Atmaram Power and Dr. R.S. Gaud, Modern Dispensing pharmacy, career publication,

2006.

2. Dr.G.Vidya Sagar, Pharmaceutical Industrial management, Pharma book syndicate,

2005.

3. Guidelines for the maintenance of central ESI medical store.

4. Dr.Mahesh D. Burande, Principles and practice of Drug store administration, Nirali

Prakashan, 2007.

5. Dr. Mahesh Kulkarni, Business Accounting, career publications, 2014.

6. Mohan Singhal and Jaidev, Drug store and business management, P V books, 2011.

7. Practical manual, PGDHHM-02, Introduction to management II, IGNOU, 2001.

8. R.M. Mehta, Drug store and Business Management, Vallabh prakashan 2001.

9. S.H. Merchant, A text book of retail pharmacy management, B.S. Shah prakashan,

1988-89.

10. Sukhdev singh, Paramjit singh, Drug store Business Management, S. Dinesh and Co,

1999.

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